External facilitators' perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework
External facilitators' perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework
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DOI：
10.1186/s12913-020-5011-3
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发表时间：
2020-03-04
影响因子：
2.8
通讯作者：
Bauer, Mark S.
中科院分区：
文献类型：
--
作者：
Connolly, Samantha L.;Sullivan, Jennifer L.;Bauer, Mark S.
背景：促进是一个关键的战略，可能有助于成功实施医疗创新。在混合促进中，外部促进者（EF）指导和支持内部促进者（IF）指导实施过程。i-PARIHS框架的开发人员提出，成功的促进需要项目管理、团队/流程和影响/谈判技巧。目前还不清楚在现实世界中，哪些综合框架技能最重要，这可以为招聘和培训工作提供信息。由于以前的IF技能的定性研究只采访了IF，他们的EF合作伙伴的观点是必要的。此外，人们对综合框架和环境框架之间执行任务的分配情况知之甚少，一旦外部支持被取消，这可能会影响可持续性。因此，在实施试验的背景下，我们：1）从EF的角度评估了IF使用i-PARIHS促进技能的情况; 2）确定了IF不包含在i-PARIHS技能中的属性; 3）调查了IF和EF在促进过程中的相对贡献。方法：在一项混合II型试验中进行了分析，该试验利用混合促进在9个VA的精神卫生团队中实施协作慢性护理模式。医疗中心。在12个月内，每个地点都有一个小组和一个综合框架参加每周的流程设计会议和额外的执行活动。三名执行主任分别在三个地点工作。研究完成后，EF完成了半结构化的定性访谈，反映了促进过程，由i-PARIHS促进技能领域的通知。访谈进行了分析，通过直接的内容analysis.Results：EF强调的重要性，IFs具有强大的项目管理，团队/流程，影响/谈判技巧。以前在这些领域的经验和心理健康背景也有好处。个人特征（例如，灵活、果断）被认为是至关重要的，特别是在面临冲突时。EFs讨论了明确界定EF/IF角色的重要性，以及将促进责任转移到IFs.Conclusions的必要性：关键IF技能，根据EFs，与i-PARIHS建议一致，但IFs的个人特征也被强调为重要因素。调查结果突出了在选择国际单项体育联合会和潜在培训领域时需要考虑的特点（例如，冲突管理）。环境基金和综合基金必须确定促进任务的适当分配，以确保做法的长期可持续性。
Background: Facilitation is a key strategy that may contribute to successful implementation of healthcare innovations. In blended facilitation, external facilitators (EFs) guide and support internal facilitators (IFs) in directing implementation processes. Developers of the i-PARIHS framework propose that successful facilitation requires project management, team/process, and influencing/negotiating skills. It is unclear what IF skills are most important in real-world settings, which could inform recruitment and training efforts. As prior qualitative studies of IF skills have only interviewed IFs, the perspectives of their EF partners are needed. Furthermore, little is known regarding the distribution of implementation tasks between IFs and EFs, which could impact sustainability once external support is removed. In the context of an implementation trial, we therefore: 1) evaluated IFs' use of i-PARIHS facilitation skills, from EFs' perspectives; 2) identified attributes of IFs not encompassed within the i-PARIHS skills; and 3) investigated the relative contributions of IFs and EFs during facilitation.Methods: Analyses were conducted within a hybrid type II trial utilizing blended facilitation to implement the collaborative chronic care model within mental health teams of nine VA medical centers. Each site committed one team and an IF to weekly process design meetings and additional implementation activities over 12 months. Three EFs worked with three sites each. Following study completion, the EFs completed semi-structured qualitative interviews reflecting on the facilitation process, informed by the i-PARIHS facilitation skill areas. Interviews were analyzed via directed content analysis.Results: EFs emphasized the importance of IFs having strong project management, team/process, and influencing/negotiating skills. Prior experience in these areas and a mental health background were also benefits. Personal characteristics (e.g., flexible, assertive) were described as critical, particularly when faced with conflict. EFs discussed the importance of clear delineation of EF/IF roles, and the need to shift facilitation responsibilities to IFs.Conclusions: Key IF skills, according to EFs, are aligned with i-PARIHS recommendations, but IFs' personal characteristics were also emphasized as important factors. Findings highlight traits to consider when selecting IFs and potential training areas (e.g., conflict management). EFs and IFs must determine an appropriate distribution of facilitation tasks to ensure long-term sustainability of practices.